2 Program objective: How to help people with diabetes in emergency situationsLearning objectives:Understand basic diabetes managementDiscuss emergency needs as related to basic diabetes managementUse tools for determining medication and SBGM needsHandoutsPre and post surveysInfo about DPC and campBasic free lit kit + insulin, medications and high/low blood sugar sheetsMonitoring and medication flow charts

3 What is diabetes?Diabetes is a disease that affects the way your body uses the food you eat for energy.Diabetes happens when:Your body does not make any insulin,Your body does not make enough insulin, orYour body does not use the insulin it makes the right wayThere is no cure for diabetes, however, it can be managed.Diabetes is diagnosed through a blood test. After the age of 45, a blood glucose test every 3 years or yearly if there are symptoms or risk factors present

4 Risk Factors for developing diabetesBeing over 45 years oldHaving blood relatives with diabetesBeing over weightBeing a person of colorNot exercisingHaving high cholesterol or heart diseaseHaving high blood pressureHaving diabetes when pregnantHaving a baby that weighed over 9 pounds

5 Symptoms of Diabetes Increased hunger Being very thirstyFrequent urinationBeing very tiredSlow healing woundsChanges in visionTingling or numbness in hands or feetUnexplained weight lossFor some people, these symptoms of diabetes can be very subtle and go unnoticed or be attributed to something else.For people with diabetes, these symptoms can be experienced when blood sugars are elevated or not under good control

6 Types of Diabetes Type 1 diabetes Type 2 diabetes Gestational diabetesDiabetes is a chronic illness…that means there is no cure, however, it can be managed.Type 1 diabetes usually develops before the age of 30 but can happen at any age. We tend to see it in children. The body no longer produces insulin, so insulin injections are needed along with healthy eating, exercise and monitoring blood sugar.Type 2 diabetes usually develops in adulthood, but we are seeing it in children also. Type 2 diabetes is the most common type of diabetes. The body is still producing insulin, however not enough is being produced or what is produced is not being used effectively in the body. Management of type 2 diabetes includes healthy eating, exercise, medications in needed and monitoring blood sugar.Gestational diabetes occurs during pregnancy and is the only type of diabetes that can go away. Usually (but not always) mom’s blood sugar will normalize after the baby is born. Gestational diabetes is managed through healthy eating, exercise, medications if needed, and monitoring blood glucose.

8 Healthy Food Choices There is no “diabetes diet” General GuidelinesEat 3 meals each dayEat at about the same time each dayDo not skip mealsWatch the fat!Watch your portion sizeLearn to read and use food labels

9 Healthy Food Choices in EmergenciesMeals every 4-5 hoursBetween meal snacksCarbs at each mealFruit, starches / grains, vegetables, milk / yogurtServe sugar-free beveragesServe heart-healthy foodsWhat are some of the foods you have served in the past? Let’s see if they fit or what suggestions can be made to make them fit better.If people do not eat, they may experience hypoglycemia.

12 Physical Activity Lowers blood sugar Lowers blood pressureLowers cholesterolHelps you sleepEnhances your moodHelps burn fatHelps build muscleStrengthens bonesThere are a lot of reasons to be physically active including lower blood sugar levels! It is recommended that we start slowly and work up to 150 minutes per week.

13 Physical Activity in EmergenciesDepending on the nature of the disaster, there may be a change in regular activityIncrease in activity due to repairing damageHypoglycemia (low blood sugar)Decrease in activity due to being away from routineHyperglycemia (high blood sugar)Excessive exercise when blood sugar is over 250mg/dl may cause blood sugar to elevateThings to think about when it comes to diabetes, physical activity and disasters.

14 Checking Blood GlucoseTells what your blood glucose number is NOWIs used to make changes in how you manage diabetesHow food and activity affects your blood glucoseHow well diabetes medicines are workingEffects of stress or illnessPeople with diabetes should be checking their blood sugar. Checking blood sugar tells what the blood sugar number is NOW. The results can help you and your doctor know how well your diabetes is doing and if you need to make changes in how your are managing it.Testing should not be discontinued during an emergency situation. It is just as important to test now because of the stresses of the situation (erratic eating, possible problems with medications, stress).Pass out and review the blood glucose testing supplies flow chart

16 Diabetes MedicationsPeople with diabetes may need to take pills and/or insulin to help manage their diabetesTaking pills and/or insulin does not mean your diabetes is worse than someone else.It means that this is the best way to way to manage your diabetes.

17 Diabetes Medications in EmergenciesPeople with diabetes may or may not be taking diabetes medicationsOral medications do not require special storageInsulin or other injectable medications require special storage and equipmentSyringesPen needlesAlcohol swapsPump suppliesSharps containerPass out and review medication flow sheet.Note names of some diabetes medications and insulin on back of flow chart. Many have similar sounding names which makes it easily confusing.

19 Stress and Diabetes Coping skills may be inadequate for situationDecreased sleepIncreased worryDamage to property“Where will I go?”Loss, grief, fear, anger, frustrationChange in prioritiesPreoccupation with survival or clean upStress can raise blood glucose. People with diabetes should test more often, drink sugar-free beverages or water when blood sugar is elevated, seek counseling of some sort if needed.

20 Low Blood Sugar Blood glucose of less then 70mg/dlFeeling weak or tiredBeing hungryFeeling sweaty, having chills or cold handsFeeling shaky, anxious or confusedHaving a fast heart beat, dizziness, or headacheHaving blurry vision or numb lipsPassing out or having seizuresSome people with diabetes, especially those taking insulin and certain oral medications, may develop low blood sugar or hypoglycemia. A blood sugar below 70 is considered low and should be treated.Symptoms include:Feeling weak or tiredBeing hungryFeeling sweaty, having chills or cold handsFeeling shaky, anxious or confusedHaving a fast heart beat, dizziness, or headacheHaving blurry vision or numb lipsPassing out or having seizuresSymptoms can be mild to severe.Causes of low blood sugar include:Skipping meals or snacksNot eating at the right timeNot eating enough foodDrinking too much alcoholUnplanned or increased physical activityTaking too much diabetes pills or insulin or not taking it at the right timeIncreased stress (physical or emotional)

23 Other Things to Consider in EmergenciesProblems with feetPoly-pharmacyWhere to get medsOther medical conditionsHeartBPVisionProsthetic devicesDialysisFor people with diabetes, problems with feet can get bad fast. Cuts, bruises or open wounds on feet need immediate attention. Check feet daily, keep them clean and dry, do not go barefoot.It is not uncommon for people with diabetes to have other health issues (heart disease, hypertension) and be taking more than one type of medication.Low vision may be an issue for people with diabetes, especially older people with diabetesProsthetic devices and dialysis are not as common but you should be aware that they are possibilities. There are power point presentations of these topics on the CCBOH website.

24 When to call for help Refer to a hospital, clinic or ER when:Hypoglycemia that does not respond to treatmentConsecutive blood glucose readings greater than mg/dlBlood glucose reading greater than 250 mg/dl along with vomiting, rapid breathing, fruit breath, stomach ache

25 Emergency or Disaster SituationsSituation: Person with diabetes had been stockpiling insulin in refrigerator from when she had health insurance. Her power went out for 5 days during hurricane Sandy. She was able to remain in her home, but her main concern was how to keep unopened insulin cold (between degrees) so it would not be destroyed.Her options included:Store someplace until power came on (which is what she did)Keep in refrigerator and monitor temperature. When temp. goes above 46 degrees, transfer to freezer compartment and continue to monitor temperature.Check temperature of garage. Move to garage if temp stays between degrees. Monitor temperature.These options require having a refrigerator/freezer thermometer (which most people do not have).Do not put on ice or in a cooler with ice. You do not want the insulin to freeze!Monitor “look” of insulin (see insulin handout). Some insulin should be cloudy; others should be clear. If the look of the insulin changes, do not use.If insulin becomes stringy or develops crystals, do not use.If staying in an emergency shelter, make room for unopened insulin to be stored. If staying in a hotel, make accommodations for unopened insulin.

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